Radical resection of anterior skull base tumors.

The transfacial approaches give the surgeon wide exposure for resecting skull base lesions. The classification system, using six levels, helps plan the best surgical strategy. Our experience with the transfacial approaches has been associated with acceptably low rates of morbidity and mortality. Our small experience with carotid sacrifice reflects our practice of preserving the ICA whenever possible. We recommend preserving the ICA with benign tumors because they do not invade the artery, or they invade it to a limited extent. In contrast, we recommend radical tumor resection and sacrifice of the ICA with malignant tumors, because they directly threaten the integrity of the ICA and a patient's survival. The ICA should not be considered a limitation to radical tumor resection, because the ICA can be safely reconstructed with an appropriate bypass procedure.